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Tuesday, October 30, 2018

It's been a wrenching week for our home country. In Kentucky, Maurice and Vicki were shot and killed, both in their 60's; they seem to have been targeted for being black. Across the country, people from Joe to Kamala to Tom, 14 in all, were mailed pipe bombs to punish their political views. In Pittsburgh, people from Bernice to Rose to David, 11 in all, were hunted down with an automatic rifle in their synagogue, for being Jewish. Rose was 97 years old. I am using first names because I find that humanizing. These are ordinary Americans going about their ordinary lives, crashing into hate. You could have been friends with their children, or borrowed their car, or had dinner at their table. These are real people, innocent people, with their own stories.

In this situation, it becomes easy to be riled. To lash back. To ridicule, or to despise the perpetrators, to erect some sort of moral pedestal from which to feel dissociated from the mayhem. To comb through politics and leadership for blame.

So this is a crucial time to remember that love will win. That hate is temporary. That the most powerful way to respond to hate is to choose to love.

This week, Pittsburgh responded with love. A Muslim crowd-funding site raised over a hundred thousand dollars for the burial costs of the massacred Jewish worshipers. So many people packed the city-wide rally that half had to stand outside in the freezing weather. I see campaigns popping up on social media to practice random acts of kindness to strangers as a way to authentically counter the sorrows that have befallen us. The mayor affirmed: we are one. The rabbi refused to be drawn into partisan politics, reminding us: speaking hatefully only makes the problems worse. There are some leaders in America still trying to see each other as humans first, still trying to calm fears and build bridges. And that is what we need.

Martin Luther King, Jr., preached love while absorbing hate right up to his death. As did Jesus.

A week from today Americans will go to the polls. We far-away types had to mail our ballots in early. This excellent opinion piece by Pastor Tim Keller reminds people of faith that a. we must participate in the political process to love our neighbors, but b. the Kingdom of God and the kingdoms of the earth never perfectly align. So read up on your candidates, think hard about the common good for everyone from the unborn to the elderly to the earth, make your hard choices with confidence that love will overcome evil in the end.

From my devotions this morning (commentary on Matthew 28 by NT Wright): "People get very puzzled by the claim that Jesus is already ruling the world, until they see what is in fact being said. The claim is not that the world is already completely as Jesus intends it to be. The claim is that he is working to take it from where it was--under the rule not only of death but of corruption, greed and every kind of wickedness--and to bring it, by slow means and quick, under the rule of his life-giving love. And how is he doing this? Here is the shock: through us, his followers. The project only goes forward insofar as Jesus' agents, the people he has commissioned, are taking it forward."

Monday, October 29, 2018

How many people do you know who have published illustrations for four books before they are legal adults? So this is a short tribute to a remarkable life-in-progress. Acacia started helping me when she lived in our house for most of the first three years of high school, commuting from South Sudan. She had spent her early years inseparable from our kids as we all lived in Bundibugyo, Uganda, together, so she was a natural fit in our family. And since she had spent her entire life in the Rwendigo settings, she could see what I was seeing as I wrote. Only unlike me, she could also draw it!

Today we celebrate that artist's soul, the attention to the tiny details like wave ridges in the sand, or the way sea urchin spikes are oriented. Acacia's eye finds beauty, pattern, integration, setting where most of us take the world for granted.

Acacia has also been a lover of animals from a young age, from pet goats and rabbits to a passion for dogs and donkeys. If you read the third book (A Forrest, a Flood, and an Unlikely Star) the featured messenger is a tribute to Acacia, and some of her favorite lines make it into the dialogue. Had she not embraced art therapy as a means of blessing the world, she probably would have worked in animal husbandry or veterinary medicine. But both demonstrate a heart for the overlooked, a willingness to get into the mess to be redemptive, a broader view of this world and its needs with an intent to serve even if it is costly. In other words, spunk.

Growing up in three African countries plus regular immersions into American culture is no small task. It takes a strong dose of resilience to navigate languages, climates, cultural systems, chaos across continents. I appreciate Acacia's imperturbability. She is comfortable enough in who she is to enter into other lives without having to be the center of attention. She holds onto humor, listens deep into the night to her friends, bakes therapeutically, and has a gift of encouragement.

So join me today in wishing Acacia a spectacular 21rst birthday, definitely a somewhere-milestone of grace that gives me an opportunity to thank God and her parents for this life!

Sunday, October 28, 2018

October seemed so promising for the first couple of weeks, as we celebrated some encouraging discharges, some unlikely healing, some cheering morale. But the nature of serving in a marginal place is this: even doing the right thing with all we have is often not enough. Sure, scores of preemies have been discharged over the last weeks, and remarkable resuscitations have seen lives saved. But the OB team had their first maternal mortality in months Friday evening, and the Paeds team has had a discouraging run of septic twins, severe asphyxia, an abandoned hypothermic baby found in the bushes, home deliveries brought in days later on the brink of death, tiny prematures born on the way, all not making it past the first 24 hours. I made a graphic for a lecture recently that described all the massive societal injustices that impact HIV prevalence and severity, and drew a tiny arrow to represent the medical impact of getting the medications right. It helps, but it doesn't solve all the huge gaping wounds of poverty, violence against women, lack of transportation, inadequate staffing, corruption, and on and on.

As we passed our October quarter-century-in-East-Africa milestone, I've been thinking a lot about endurance and burn-out. The years do not make one immune to discouragement, or confer the wisdom to not rail in the heart against a thousand frustrations. A friend sent us an article about physician PTSD in the USA that described current medical life as "death by a thousand paper cuts", the idea that the accumulation of small constant assaults on your sense of purpose and joy accumulates to a career-ending level. Not everyone's story is the same, and longer does not necessarily mean better (and we would thoroughly encourage, actually for our organization, MANDATE, serious time for healing and reflection for anyone sensing such a loss of hope and vision). But by grace and prayer here we are on a rainy afternoon many thousands of miles from our immediate family and if it is any help to those a few years behind, here are some reasons why.

Grace through you. Your prayers. This has to be the top of the list. A thousand may fall, but if God still has work to do in and through us, still has a path for us here, then here we remain. That may sound like a sloppy syllogism, but deep down we have to humbly (Psalm 91) acknowledge it is true. Many people do everything possible for a long and healthy cross cultural career and they are dealt an unsurvivable blow. We have not been.

The Burning Paradox. I think that most of us would assume that to prevent burn-out, we should turn down the flame. However, a couple of weeks ago I read a thought-provoking article by a physician who suggested that delving deep into harder work actually might bring more satisfaction, which in the long run might keep you going. Perhaps instead of turning down the flame, adding more fuel? I do think that for our particular wiring, being all-in committed to a team, a project, a patient, can paradoxically bring life. At various times for us, that has meant pioneering HIV prevention, innovative nutrition programs, investing in medical education, or perinatal care for maternal and infant survival. (below, a malfunction in the camp stove this weekend seemed to illustrate the point).

The Bigger Picture. Being part of an arc of redemption that extends through history, being a tiny footnote in a glorious story where all shall be well, all manner of things shall be well. We don't see evidence of this everyday unless we look very hard, but by faith we hold onto this truth.

The Community of Colleagues. We cannot overstate the uplift of a team, the life-saving attitude-rescuing essential of working in community. Our fellow Sergers, our Kenyan counterparts, our daily interactions with trainees, the nurses, the neighbors. Work for the common good, done with the and for the community, brings a sense of belonging. We are relational humans; and that human touch can make all the difference. A corollary to this is investing in younger people, in students particularly. Passing on our gifts by creating a human bond while teaching.

Countdown against Futility. Atul Gawande advises medical students: count something . An act of measurement fights the temptation to believe all is vanity. Change can be slow. We can lose sight of hope, and think nothing changes in spite of our efforts. So accumulating a few facts to the contrary can build a sense of curiosity, which is close to a sense of purpose.

The Leavening of Levity. There is plenty in every day to mourn; it takes commitment to keep finding the humor. But honestly the difference between a spiral of sorrow and a plodding resilience can be the ability to regularly see irony or absurdity, to not take ourselves completely seriously. We need help with this sometimes. But if you can't laugh at your own ridiculousness, it's time for a break. It's OK to acknowledge our mistakes, to even laugh at them. Which brings us to the final thought.

Rhythms of Sabbath and Festival. The ancient culture of one day's rest in seven, three all-culture week-long assemblies laden with food and fellowship, still bears wisdom. If we can't step away from work we start to imagine that everything depends on us. Once we were asked to speak to young doctors and said, while you're in Africa, take your family on safari, even if people die while you're away from your hospital. It felt a little risky to say that, but we still believe it is true. We are not God. When we unplug from duty and demands, immerse in beauty and quiet, we gain staying power for more good overall. This is perhaps the counterpart to #2, a work-hard rest-hard philosophy. This week we spent one night in a tropical rainforest, a small community-run campground, hiking in the mist, listening to birds. Less than 24 hours, but it was another bolster of refreshment to return to the mess ahead.

I am well aware that even as we ponder the grace that has kept us thus far, we do not know what's around the corner. For this moment, however, these are the truths to which we bear witness. They actually align pretty closely with our organization's core values: the big good-news picture, the foundational centrality of prayer reflecting unseen realities at work, embracing vulnerability, focusing on loving people.

Tomorrow will probably bring a 30th death for the month. It will probably bring some disappointment, some mistakes, something important we miss, some longing for those we love, some awareness of our weakness and temptation to hide or pretend. But we pray for ourselves and those we supervise that tomorrow will also bring eyes wide open to the deeper realities, curiosity to investigate and delve deep, connection with others, and a few laughs. And a rhythm that paces us into the next 25.

Tuesday, October 23, 2018

These two young men met as Senior One students (middle school equivalent) in January 2004. Luke was 11, about to turn 12, and Katuramu was a few years older. Luke had grown up in Bundibugyo for those 11 years, and Katuramu across the mountains east in Fort Portal. Katuramu's father died before he was born, and his widowed, older mother struggled to educate him. A neighbor noticed that he was bright and eager and hard-working and recommended a primary school started in association with Serge missionaries and Ugandan church leaders, which included a Good Samaritan sponsorship program. He excelled throughout primary school and the program decided to send him to Christ School Bundibugyo for secondary. Luke spent his primary years at our team's Rwenzori Mission School, plus part-time in local Ugandan schools. As we began 2004, he seemed ready for the more focused science and math of CSB and for the needed peer interaction and sports. And so began a true friendship. Both were relative outsiders, both were intense and competitive students active in math club and chess club, both were leaders in character and grace. Four years later when they sat for O levels, Katuramu was number one in the district, and Luke was number two.

Luke went to Kenya to board at Rift Valley Academy for two years instead of A level; Katuramu completed A level in Uganda. Their paths would diverge and reconnect over the years as their friendship continued. Katuramu's mother also died, and Luke walked over the mountains to be with him for the burial. As Luke began University in the USA, we drove Katuramu to various medical schools in Uganda until he was admitted. The Good Samaritan program continued half-sponsorship of Katuramu and the Kule Leadership fund the other half; Luke received a nearly full scholarship for University and half-scholarship for medical school, as God continued to provide. Katuramu finished his internship, married Carol, worked some, had his first baby, earned a spot in the Kabarak University Family Medicine residency (master's) program. Luke graduated from medical school and matched at University of Utah for Orthopedic Surgery.

Which means that in two months it will be 15 years since they met, and they are both first-year residents in excellent training programs, still with hearts to serve the poor, to use their education and the gifts God has given for the world's good and God's glory. Katuramu's program is 4 years, Luke's is 5. Luke had a one-week vacation in October, and his program agreed to sponsor a plane ticket so he could make connections back in Kenya for ongoing research. With travel, he had 4 days on the ground in Kenya--3 working with orthopedic surgeons and research nurses and residents at Kijabe, and one to drive out to Nakuru and see his friend Katuramu.

I am telling this story to illustrate the power of investing in education for the people who seem to be at the margins of the world's power. Luke, by American standards, grew up poor and isolated. Katuramu, by any standards, grew up with zero human chance of becoming a doctor. At a critical time in their lives, they spent four years at Christ School. They had competent, demanding teachers. Labs. Books. They had weekly discipleship in chapels and cell groups, a focus on servant-leadership, on character, service, integrity, faith. They had friendships with each other and other students. For many CSB students, their time as boarders is the most consistent nutrition and safety they receive in their life. They experience in those years an alternative world system, where might does not make right, where corporal punishment (illegal in Uganda) is actually not practiced, where the faculty and administration model sacrificial Kingdom-oriented lifestyles, where hard work can change your trajectory, where prayer is more powerful than witchcraft, where a teacher sexually abusing a student is not considered normal or acceptable. CSB is a tiny island of alternative life in a vast area of the world where women have little respect, where survival is far from assured.

I'm slightly nostalgic from the reunion of these two friends, but in the last week or so I've also received these photos on my phone from other kids we have sponsored:

John in the green and Isaiah in the white shirt both graduated from CSB in Caleb's class. John went on to study accounting and passed his very demanding CPA certification; he works with Josh (center, our Bundibugyo Team Leader and Chairman of the Board for CSB) now. Isaiah was a couple years behind Katuramu graduating from medical school (also on the Kule Leadership program) and is now starting internship. He wants to complete his training as a general surgeon.

Mutegheki (in the red) with Josh and John again . . he was the top graduate in his class with a degree in business from Victoria University a month ago, and is working now in Fort Portal.

These young people have hearts for service, and CSB gave them the essential boost to get the training they need. They are connected, loyal, bright, and hopeful. And they are joined by scores of others who have graduated, who are now teachers, lab techs, pastors, nurses, famers, electricians, librarians, and on and on. A generation that is poised to move a valley below the Rwenzoris forward towards health and wholeness. As we come to the end of the 2018 school year in November, we know that there will be a financial gap. The year started in drought and the cocoa harvest was not robust. CSB's model is to charge parents about half of the actual cost of education; the other half comes from people across the world who care about Bundibugyo, who want to love God in a practical way and look for a gift that keeps multiplying. This fund allows CSB to keep producing Katuramus, and Lukes, and Johns, and Isaiahs, and Muteghekis (and half of our students are girls; they just haven't sent me photos in the last two weeks!). Feel free to join us.

(To learn more details about Christ School visit the school's website HERE!)

Friday, October 19, 2018

Both are pictures of a glimmer of light through some dark clouds. In the first, Scott and I were talking our evening debrief walk with the dog (sanity 101) after a heavy rain, and startled by a spectacular rainbow. In the second, I was walking back into hospital after teaching a core lecture on sepsis to our interns on Paeds, and they were in high spirits having just had a good teaching time and lunch, and suggested a photo together. The pharmacist stopped the group and said, what's going on? And it clicked for me: we were having a good day because we had stopped to celebrate some victories. In fact I had snapped photos of several milestone patients who were healing, and shared them on our patient-care what's-app group, which unexpectedly led to a totally changed atmosphere for the day.

The power of noticing the good, when mostly we are steeped in murkiness and sorrow. This is a hospital where a baby or child dies on about half of our days (that's actually probably an underestimate). A dear Kenyan friend who had been away in England two years took her first Kenyan call this week, and had a rough night over a critically ill child who ended up dying. It was the first death she had had in two years of work. Let that contrast sink in.

So somehow, by prayer or the Spirit or confluence of noticing hopeful events, yesterday we took time to celebrate.

Baby L was our first thanks. He was admitted for two weeks, with kidney failure and crazy high sodium in his blood due to dehydration, infection, a mom without milk . . and he went home completely normal.

These two preems (unrelated) had been with us for 55 and 57 days, both 28-weeks out of 40-weeks gestations, dipping below 1 kg (2 lb) and they went home healthy and well after many struggles. The intern who carefully monitored them really felt the sense of accomplishment.

This little girl came in so anemic and sick she was nearly dead. She turned out to have TB and some other issues, and after two weeks of anti-TB medicines she is headed out the door with a new chance at life. Her mom turned from somber to hopeful.

The triplets: All boys, and though one is Shadrack the other two aren't Meshack and Abednego (much to my disappointment). The first-born as usual is the biggest, and being about 200 grams ahead of his brothers, he graduated from the incubator today!

Here are two incubators worth of babies on the bench, while their moms make their beds. I don't think we've had less than 50 babies in the Newborn Unit any day all month.

This preteen (face blurred) lost both parents to AIDS, and came in weighing less than the average kindergardener. After weeks of nutritional rehab, and much advocacy, she got some more advanced treatment for her primary problem, a miracle worth celebrating. She gained 4 kilograms and went home with her older sister who is her caretaker.

Scott explaining how to monitor labor to all the interns . . including the basic stuff by which lives are saved.

So join us in that moment when the light breaks through, when the clouds are not the only reality, when team work produces some life-saving results, when we get a view of redemption. Bask.

Wednesday, October 17, 2018

Last night, the three of us back at another East African Airport celebrating an arrival

25 years and 3 days ago today, Scott, Luke (8 months old) and I landed at the old Entebbe airport. It was October 14, 1993. The airplane doors opened to the familiar smell of wood fires in the early morning air, and we walked across damp tarmac to the terminal. We cleared immigration and customs with our stack of trunks, and piled them outside to wait. And wait. And wonder. No one had come to meet us. Those were the days before cell phones, and we realized we were in a country where we knew very little with no plan B. A few taxi drivers tried to talk us into their hotels. We knew that the small Serge team sometimes stayed a night at the Sheraton (formerly a place of glory, but in the early 90's emerging from the days when guests had to scrounge for their own food to cook over charcoal on their balconies) because it was the sole place one could place an international phone call, from a wooden booth in the lobby. Lake flies swarmed, which I mistakenly thought were mosquitoes, sure that our baby was going to die of malaria before we could even get our bearings. After a couple of hours, Atwoki pulled up in the Herron's truck. They were all sick, and unable to come get us. It was the first of many times Atwoki would rescue us over the years!

We spent the first few days in the Namirembe Guest House, simple dorm-like rooms and group meals. Lynn L gave me a grocery list on a piece of yellow legal paper that I saved and used as a reference for many years: staples like flour and sugar by the kilogram, luxuries like toilet paper and powdered milk, we purchased from duka #24, a small open street-side shop in the massive Nakasero Market area. No malls, no grocery stores, no bottled water (it was boil and bring your own). While Lynn helped me (who had hardly ever even cooked) stock up for survival, Paul took Scott through the process of claiming the imported Landcruiser we had purchased months before. And then we left for Bundibugyo. The paved road ended just an hour outside Kampala, and from there it was a twisting, rutted, mud-holed trek west, about 12+ hours of driving that had to be split over two days.

When we pulled up to Bundimulinga, and stepped out, I clearly remember my very first thought: there are mountains! Of course I knew that from a map, but seeing a map symbol and the real thing are two very different experiences. The rainy season clarity revealed snow-capped peaks rising up behind our new home. For a girl from West Virginia, those mountains felt like a personal gift from God, unnecessary beauty and connection just because of God's love.

And so the story goes for 25 years, 1993 to 2018. Unnecessary grace, overflows of love. Right down to the detail that 25 years and 2 days later, that 8 month old would be returning to Africa as an orthopedic surgery intern to work on establishing a research collaboration, the three of us back in East Africa at an airport once again. Stay tuned for the next 25 . . . .

Sunday night the 14th, our actual 25 year mark, waffles and ice cream with the Ickes kids to celebrate

Catherine's commemoration

Last night on the way to the airport, Ethiopian with the Rigbys and the Niharts (Nairobi). Balm to the soul.

Miss Salem in 2018, the exact age of Luke in 1993.

This morning, entering Kijabe Hospital to greet old friends and connect Luke with the fine orthopedic surgeons who provide excellent care for the vulnerable in this place. Quite a full circle sort of day.

Sunday, October 14, 2018

He will not allow your foot to be moved;
He who keeps you will not slumber.
Behold, He who keeps Israel
Shall neither slumber nor sleep.

The LORD is your keeper;
The LORD is your shade at your right hand.
The sun shall not strike you by day,
Nor the moon by night.

The LORD shall preserve you from all evil;
He shall preserve your soul.
The LORD shall preserve your going out and your coming in
From this time forth,
And even for evermore.

Psalm 121.
My dad's favorite, and the lectionary for yesterday, as we climbed Mt. Longonot.
A lovely confluence of poetry and life that reminded us of our God's attention to details.

Today we marked 25 years since landing in Uganda to begin our work with Serge. A full post about that is coming.
But yesterday, we wanted to carve out a time to bear witness in our own hearts to God's faithfulness over that quarter century. So we camped at the base of the dormant volcano nearby in the Rift Valley, started our ascent in the dark, and watched the sun rise from the rim. We've done a lot of going out and coming in, seen a lot of smiting sunshine and shifting moons, felt a lot of near-stumbles and nearby evil, over these years. Yet here we are, climbing and praying and leaning into the God who preserves our souls.

Rejoice with us, enjoy Scott's photos, and stay tuned for some more nostalgia.

Thursday, October 11, 2018

This is what a week looks like. Tiny feet, too many of them, waving from the broken doors of four over-stuffed incubators (we have 14 preems in 4 incubators today, that's 4-4-3-3). Moms carefully expressing milk, sitting patiently on benches, breaking into smiles when released to go home. An HIV-infected 5 year old with TB revived by a blood transfusion and TB meds, whose mother's apathy seems to fade with each day of her survival. Abscesses drained and packed with guaze, IV cannulas inserted, oxygen tubing connected, weights charted. Gathering interns for teaching, buying them lunch as we go step by step through the complicated fluid calculations for dehydration with kidney injury. A departmental review of all the deaths in a month, the sorrow of each case, the obscurity of trying to discern what went wrong. A holiday, whose celebration was unclear up until 12 hours before . . . Scott and I sense we should just bike over mid-morning to check up on things . . . and find a mother referred on a public matatu unconscious from ecclampsia (high blood pressure and convulsions associated with pregnancy) . . . Scott mobilizes the emergency cesarean staff and calls me to join as the mother shakes with seizures. He pulls out a nearly dead, totally limp and still baby from a womb thick with meconium (stool). There is a faint heart beat but nothing else, but slowly the baby comes to life as we give breaths and oxygen and dry. Mother and baby are both in critical condition but alive and possibly will be fine.

A week also looks like this: for every exciting save, another sorrowful death. Today I walked into the ward and found a mom making fun of my Swahili, loudly, with the others laughing. I know it's not typical, but it was surprisingly humiliating. Or the antibiotics are out of stock, or the person on call was not found to help so there is a terrible outcome, or the oxygen runs out, or we get messages one after the other of absences. Or a c-section gets delayed by the reluctance of the anesthetist or someone else to step into their job, and the next day Scott checks for a fetal heart rate, and it's not there. Or we get a glimpse of how our own mothers feel our distance, or how our own kids have challenges we can't help with.

This is what living vulnerably in the real world looks like. We are not in control of a thousand things around us, we are just showing up and trying to do our best. Trying to be a flickering light. Trying to bring a small measure of order, accountability, education, healing into a place where some people are eager for the mentoring and burden-sharing, and others may resent the intrusion. Trying to walk a line of faith, of praying against injustice, of seeing the best in others, of waiting for God to act . . . without feeling complicit in a system that is deeply flawed.

And as we continue, a few things happen. First, we get a front row seat to redemption and restoration. Baby A. above finishes 17 days of treatment today, finally with a firm lifeward direction after a severe pneumonia that required a powerful, expensive antibiotic. Second, we find our in-this-boat-together powerlessness draws us into community with others. Our weekly prayer time has a few new attenders. This week we talked about Hagar, and the interns could deeply relate to feeling used, feeling without choice, feeling lost and alone and desperate. Hagar the foreign slave tries to escape, but God sends her back. Her path of humility leads to the dangers of childbirth (still dangerous now, imagine several thousand years ago) and the inglorious, demeaning life of a captive. Yet Hagar gets to see, and be seen by, God. So the third perk is just that: this is the paradox of the Kingdom, the taking up a cross, the all loss becoming gain. God is here. With our interns, with us, with our patients, and it is a worthwhile calling to point to that truth.

Ending with a reminder: this is a personal forum to bear witness to our experience of God and the world. We seek, imperfectly and haltingly, to walk into the mess, and to try to apply the logic and love of Jesus around us. As we do that, we get a hundred things wrong every day. Please don't think that our writing reflects any official Serge theological stance, or political either. We love ideas, and passionately desire to reflect on what is wrong and what could help . . and to spark others do the same. But not everyone enjoys the process, so please forgive us for diverting into American issues the last two weeks. Stick with us and don't hesitate to share with us your feedback and struggles too.

Our Mission

who we are

paradox:
1. something that combines contradictory features or qualities.
Life in Africa is full of contradictions - the beauty and pain; the abundance and the poverty; the joy and the sorrow.
Our lives, too...dying that we might live; strong in our weakness; sinners yet saints.
2. a "pair of docs"